Gokhan KARADEMIR, Onur TUNALI, Ata ATALAR

ROTATOR MANŞET YIRTIKLARINDA SKAPULA MORFOLOJİSİNİN ROLÜNÜN İNCELENMESİ: EN KULLANIŞLI PREDİKTÖR HANGİSİ?

Amaç: Bu çalışmada glenoid inklinasyon (Gİ), akromial indeks (Aİ), kritik omuz açısı (CSA) ve superior inklinasyon (Sİ) ölçümlerinin semptomatik dejeneratif tam kat supraspinatus tendon yırtıkları (SSY) ile ilişkisinin incelenmesi amaçlanmıştır. Gereç ve Yöntem: 2015 ve 2017 yılları arasında SSY tanılı hastaların verileri retrospektif olarak incelendi. SSY tespit edilen 39 hasta ile yaş, cinsiyet ve taraf yönünden eşleştirilmiş SSY olmadığı tespit edilen 39 hasta çalışmaya dahil edildi. Ölçülen Gİ, Aİ, CSA ve Sİ değerleri SSY grubu (n=39) ve kontrol grubu (n=39) arasında karşılaştırıldı. SSY grubunun yaş ortalaması 52,74±5,49 yıl, kontrol grubunun yaş ortalaması 51,15±5,22 yıl idi. Bulgular: Gİ ortalaması yırtık grubunda 19,97°±5,62° iken kontrol grubunda 13,72°±6,55° idi (p<0,001). Aİ ortalaması yırtık grubunda 0,7±0,08, kontrol grubunda ise 0,67±0,07 idi (p=0,035). CSA ortalaması yırtık grubunda 35,05°±4,09°, kontrol grubunda 33,06°±3,42° idi (p=0,022). Sİ ortalaması yırtık grubunda 25,13°±5,71°, kontrol grubunda ise 25,91°±5,81° idi (p=0,552). Gruplar arasında istatistiksel anlamlı farklılık bulunan Gİ, Aİ ve CSA ölçümlerinin duyarlılık, özgünlük ve cut-off değerleri belirlendi. Buna göre Gİ’nin ≥17,35° cut-off değeri için duyarlılığı %79,54 iken özgünlüğü %79,51 idi (p=0,001). Aİ’nin ≥0,67 cutoff değeri icin duyarlılığı %61,54, özgünlüğü %56,4 idi (p=0,031). CSA’nın ≥33,45° cut-off değeri icin duyarlılığı %64,12, özgünlüğü ise %64,54 idi (p=0,014).. Sonuç: Yüksek glenoid inklinasyon, akromial indeks, kritik omuz açısı ölçüm değerleri semptomatik dejeneratif tam kat supraspinatus tendon yırtıkları ile ilişkili iken superior inklinasyon ölçümü ile ilişki saptanmadı. Glenoid inklinasyon ölçümü semptomatik dejeneratif tam kat supraspinatus tendon yırtıklarının öngörülmesinde en yüksek duyarlılık ve özgünlüğe sahipti.

Anahtar Kelimeler:

Akromiyal indeks, glenoid inklinasyon, kritik omuz açısı, rotator manşet yırtığı, superior inklinasyon

EVALUATING THE ROLE OF SCAPULA MORPHOLOGY IN ROTATOR CUFF TEARS: WHICH IS THE MOST USEFUL PREDICTOR?

Objective: The aim of this study was to determine the relationships between glenoid inclination (GI), acromial index (AI), critical shoulder angle (CSA), superior inclination (SI), and symptomatic degenerative full-thickness supraspinatus tears (SSTs). Materials and Methods: Patients who were diagnosed with SSTs (n=39) between 2015 and 2017 were assessed retrospectively. Controls were matched to age, gender, and side. Measured GI, AI, CSA, and SI values were compared between the SSTs and control groups (n=39). The mean age for the SSTs group was 52.74±5.49 years, and the mean age for the control group was 51.15±5.22 years. Results: The mean GI for the SSTs group was 19.97°±5.62°, and it was 13.72°±6.55° for the control group (p<0.001). The mean AI was 0.7±0.08 and 0.67±0.07 in the SSTs and control groups, respectively (p=0.035). The mean CSA for the SSTs group was 35.05°±4.09° and it was 33.06°±3.42° for the control group (p=0.022). The mean SI was 25.13°±5.71° and 25.91°±5.81° in the SSTs and control groups, respectively (p=0.552). For a cut-off value of GI ≥17.35°, sensitivity was 79.54%, and specificity was 79.51% (p=0.001). For a cut-off value of AI ≥0.67, sensitivity was 61.54% and specificity was 56.4% (p=0.031). For a cut-off value of CSA ≥33.45°, sensitivity was 64.12%, and specificity was 64.54% (p=0.014). Conclusion: Higher measurement values of glenoid inclination, acromial index, and critical shoulder angle were associated with symptomatic degenerative full-thickness supraspinatus tears, and no correlation was found with superior inclination measurement. The glenoid inclination measurement had the highest sensitivity and specificity in predicting symptomatic degenerative full-thickness supraspinatus tears. Keywords:

Keywords:

Acromial index, critical shoulder angle, glenoid inclination, rotator cuff tear, superior inclination,

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1. Neer Cn. Impingement lesions. Clin Orthop Relat Res 1983;173(173):70-7. [CrossRef] google scholar
2. Lee YS, Jeong JY, Park CD, Kang SG, Yoo JC. Evaluation of the risk factors for a rotator cuff retear after repair surgery. Am J Sports Med 2017;45(8):1755-61. [CrossRef] google scholar
3. Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C. Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint?: A radiological study of the critical shoulder angle. Bone Joint J 2013;95-B(7):935-41. [CrossRef] google scholar
4. Hughes RE, Bryant CR, Hall JM, Wening J, Huston LJ, Kuhn JE, et al. Glenoid inclination is associated with full-thickness rotator cuff tears. Clin Orthop Relat Res 2003(407):86-91. [CrossRef] google scholar
5. Bigliani LU, Ticker JB, Flatow EL, Soslowsky LJ, Mow VC. The relationship of acromial architecture to rotator cuff disease. Clin Sports Med 1991;10(4):823-38. [CrossRef] google scholar
6. Soslowsky LJ, An CH, Johnston SP, Carpenter JE. Geometric and mechanical properties of the coracoacromial ligament and their relationship to rotator cuff disease. Clin Orthop Relat Res 1994(304):10-7. [CrossRef] google scholar
7. Daggett M, Werner B, Collin P, Gauci MO, Chaoui J, Walch G. Correlation between glenoid inclination and critical shoulder angle: a radiographic and computed tomography study. J Shoulder Elbow Surg 2015;24(12):1948-53. [CrossRef] google scholar
8. Chalmers PN, Beck L, Granger E, Henninger H, Tashjian RZ. Superior glenoid inclination and rotator cuff tears. J Shoulder Elbow Surg 2018;27(8):1444-50. [CrossRef] google scholar
9. Nyffeler RW, Werner CM, Sukthankar A, Schmid MR, Gerber C. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am. 2006;88(4):800-5. [CrossRef] google scholar
10. Torrens C, Lopez JM, Puente I, Caceres E. The influence of the acromial coverage index in rotator cuff tears. J Shoulder Elbow Surg 2007;16(3):347-51. [CrossRef] google scholar
11. Moor BK, Wieser K, Slankamenac K, Gerber C, Bouaicha S. Relationship of individual scapular anatomy and degenerative rotator cuff tears. J Shoulder Elbow Surg 2014;23(4):536-41. [CrossRef] google scholar
12. Chalmers PN, Beck L, Miller M, Kawakami J, Dukas AG, Burks RT, et al. Acromial morphology is not associated with rotator cuff tearing or repair healing. J Shoulder Elbow Surg 2020;29(11):2229-39. [CrossRef] google scholar
13. Bjarnison AO, Sorensen TJ, Kallemose T, Barfod KW. The critical shoulder angle is associated with osteoarthritis in the shoulder but not rotator cuff tears: a retrospective case-control study. J Shoulder Elbow Surg 2017;26(12):2097-102. [CrossRef] google scholar
14. Maurer A, Fucentese SF, Pfirrmann CW, Wirth SH, Djahangiri A, Jost B, et al. Assessment of glenoid inclination on routine clinical radiographs and computed tomography examinations of the shoulder. J Shoulder Elbow Surg 2012;21(8):1096-103. [CrossRef] google scholar
15. Garcia GH, Liu JN, Degen RM, Johnson CC, Wong AC, Dines DM, et al. Higher critical shoulder angle increases the risk of retear after rotator cuff repair. J Shoulder Elbow Surg 2017;26(2):241-5. [CrossRef] google scholar
16. Altintas B, Kaab M, Greiner S. Arthroscopic lateral acromion resection (ALAR) optimizes rotator cuff tear relevant scapula parameters. Arch Orthop Trauma Surg 2016;136(6):799-804. [CrossRef] google scholar
17. Scheiderer B, Imhoff FB, Johnson JD, Aglio J, Cote MP, Beitzel K, et al. Higher critical shoulder angle and acromion index are associated with increased retear risk after isolated supraspinatus tendon repair at short-term follow up. Arthroscopy 2018;34(10):2748-54. [CrossRef] google scholar
18. Blonna D, Giani A, Bellato E, Mattei L, Calo M, Rossi R, et al. Predominance of the critical shoulder angle in the pathogenesis of degenerative diseases of the shoulder. J Shoulder Elbow Surg 2016;25(8):1328-36. [CrossRef] google scholar
19. Kim JH, Min YK, Gwak HC, Kim CW, Lee CR, Lee SJ. Rotator cuff tear incidence association with critical shoulder angle and subacromial osteophytes. J Shoulder Elbow Surg 2019;28(3):470-5. [CrossRef] google scholar
20. Chalmers PN, Salazar D, Steger-May K, Chamberlain AM, Yamaguchi K, Keener JD. Does the critical shoulder angle correlate with rotator cuff tear progression? Clin Orthop Relat Res 2017;475(6):1608-17. [CrossRef] google scholar
21. Suter T, Gerber Popp A, Zhang Y, Zhang C, Tashjian RZ, Henninger HB. The influence of radiographic viewing perspective and demographics on the critical shoulder angle. J Shoulder Elbow Surg 2015;24(6):e149-58. [CrossRef] google scholar